Survey on Mental Health and Stressful Events
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For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Table of Contents
- Household information (DEM)
- Age (AGE)
- Gender (GDR)
- Postal code (DHH)
- Labour market activities (LM)
- Occupation group (LMA5)
- Introduction (INT)
- General health (GEN)
- Chronic conditions (CCC)
- Healthy behaviours (BH)
- Mental health services (MHS)
- Mental health (ANX)
- Mental health (DEP)
- Stressful events (PTS)
- Mental health (SUI)
- Social impacts of stressful events (SIP)
- Mental health services - contact with health professionals (SR1)
- Alcohol (ALC)
- Cannabis (CAN)
- Social provisions (SPS)
- Indigenous identity (IS)
- Sociodemographic characteristics (PG)
- Place of birth, immigration and citizenship (DEM1)
- Marital status (MS)
- Education (ED)
- Total household income (THI)
- Would you like to sign-up for future surveys? (UCE)
- Data sharing agreements (DSA)
Household information (DEM)
Household information (DEM) - Question identifier:DEM_Q05
Including yourself, how many people live in your household?
Number of people in household
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20 or more
Household information (DEM) - Question identifier:DEM_Q10
Including yourself, how many of these people are 18 years of age or more?
Number of people in household 18 years of age or more
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20 or more
Age (AGE)
Age (AGE) - Question identifier:AGE_Q02
What is your age?
Age in years
Min = 0; Max = 121
Gender (GDR)
Gender (GDR) - Question identifier:GDR_Q10
What is your gender?
- 1: Male
- 2: Female
- 3: Or please specify
Postal code (DHH)
Postal code (DHH) - Question identifier:DHH_Q25
To determine which geographic region you live in, please provide your postal code.
Postal code
Long Answer Length = 6
Labour market activities (LM)
Labour market activities (LM) - Question identifier:LM_R05
The following questions concern your activities during the week of #{DV_DAY7} to #{DV_DAY1}.
Labour market activities (LM) - Question identifier:LM_Q05
During that week, did you work at a job or business?
- 1: Yes
- 2: No
Labour market activities (LM) - Question identifier:LM_Q10
During that week, did you have a job or business from which you were absent?
- 1: Yes
- 2: No
Labour market activities (LM) - Question identifier:LM_Q15
What was the main reason you were absent from work that week?
- 1: Planned absence not related to COVID-19 (e.g., vacation, work schedule, maternity or parental leave, seasonal job or business)
- 2: Unplanned absence not related to COVID-19 (e.g., illness or disability other than COVID-19, caring for children or elder relative for non-COVID-19 reasons, labour dispute (strike or lockout))
- 3: Business closure or layoff related to COVID-19
- 4: Personal circumstances related to COVID-19 (e.g., personal safety, own or household member's diagnosis, self-isolation after recent travel, taking care of children due to school closure)
Occupation group (LMA5)
Occupation group (LMA5) - Question identifier:LMA5_R01
The following questions refer to the work or occupation in which you spent most of your time.
Occupation group (LMA5) - Question identifier:LMA5_Q01
What kind of work [are/were] you doing?
Specify the kind of work you [are/were] doing
Long Answer Length = 50
Occupation group (LMA5) - Question identifier:LMA5_Q02
What [are/were] your most important activities or duties?
Specify your most important activities or duties
Long Answer Length = 50
Introduction (INT)
Introduction (INT) - Question identifier:INT_R05
This survey covers various topics related to mental health and well-being. It is important to keep in mind that the time frame of these questions will vary throughout the survey. When applicable, please pay attention to the time frames in bold font in the questions.
General health (GEN)
General health (GEN) - Question identifier:GEN_R05
The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.
General health (GEN) - Question identifier:GEN_Q05
In general, how is your health?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
General health (GEN) - Question identifier:GEN_Q10
In general, how is your mental health?
- 1: Excellent
- 2: Very good
- 3: Good
- 4: Fair
- 5: Poor
Chronic conditions (CCC)
Chronic conditions (CCC) - Question identifier:CCC_R05
The following questions are about some "long-term health conditions" which are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional.
Chronic conditions (CCC) - Question identifier:CCC_Q05
Do you have a mood disorder such as depression, bipolar disorder, mania or dysthymia?
- 1: Yes
- 2: No
Chronic conditions (CCC) - Question identifier:CCC_Q10
Do you have an anxiety disorder such as a phobia, obsessive-compulsive disorder or a panic disorder?
- 1: Yes
- 2: No
Chronic conditions (CCC) - Question identifier:CCC_Q15
Do you have post-traumatic stress disorder?
- 1: Yes
- 2: No
Chronic conditions (CCC) - Question identifier:CCC_Q15A
Do you currently experience symptoms of post-traumatic stress disorder?
- 1: Yes
- 2: No
Chronic conditions (CCC) - Question identifier:CCC_Q15B
Have you ever been diagnosed with post-traumatic stress disorder?
- 1: Yes
- 2: No
Healthy behaviours (BH)
Healthy behaviours (BH) - Question identifier:BH_Q35
Are you currently doing any of the following activities to maintain or improve your health?
- 01: Communicating with friends or family
- 02: Communicating with health professionals (e.g., counsellor or therapist)
- 03: Communicating through social media
- 04: Meditating or seeking spiritual guidance
- 05: Exercising
- 06: Participating in hobbies (e.g., gardening, journaling or crafts)
- 07: Ensuring adequate sleep (e.g., avoiding screen time before sleep, avoiding caffeinated drinks or maintaining regular sleep cycle)
- 08: Other
- 09: None of the above
Mental health services (MHS)
Mental health services (MHS) - Question identifier:MHS_R05
The following questions are about the use of help and health care services related to problems with emotions, mental health or use of alcohol or drugs.
Mental health services (MHS) - Question identifier:MHS_Q05
Have you ever accessed any resources (on the internet, via phone or in person) to help manage your emotions, mental health or use of alcohol or drugs?
- 1: Yes
- 2: No
Mental health services (MHS) - Question identifier:MHS_Q10
During the past 12 months, did you receive the following kinds of help because of problems with your emotions, mental health or use of alcohol or drugs?
- 1: Information about these problems, treatments or available services
- 2: Medication
- 3: Counselling, therapy, or help for problems with personal relationships (Include support groups such as Alcoholics Anonymous (AA), Narcotics Anonymous)
- 4: None
Mental health services (MHS) - Question identifier:MHS_Q15
During the past 12 months, was there ever a time when you felt that you needed help for problems with your emotions, mental health or use of alcohol or drugs, but you didn't receive it?
- 1: Yes
- 2: No
Mental health services (MHS) - Question identifier:MHS_Q20
Why didn't you receive the help you needed (during the past 12 months)?
- 01: You preferred to manage yourself
- 02: You didn't know how or where to get this kind of help
- 03: You haven't gotten around to it (e.g., too busy)
- 04: Your job interfered (e.g., workload, hours of work or no cooperation from supervisor)
- 05: Access to care was limited (e.g., help was not readily available)
- 06: You didn't have confidence in the health care system or social services
- 07: You couldn't afford to pay
- 08: Insurance did not cover
- 09: You were afraid of what others would think of you
- 10: Language problems
- 11: Other
Mental health (ANX)
Mental health (ANX) - Question identifier:ANX_Q05A
Over the last 2 weeks, how often have you been bothered by the following problems?
Feeling nervous, anxious or on edge
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health (ANX) - Question identifier:ANX_Q05B
Over the last 2 weeks, how often have you been bothered by the following problems?
Not being able to stop or control worrying
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health (DEP)
Mental health (DEP) - Question identifier:DEP_Q05A
Over the last 2 weeks, how often have you been bothered by the following problems?
Had little interest or pleasure in doing things
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Mental health (DEP) - Question identifier:DEP_Q05B
Over the last 2 weeks, how often have you been bothered by the following problems?
Felt down, depressed, or hopeless
- 1: Not at all
- 2: Several days
- 3: More than half the days
- 4: Nearly every day
Stressful events (PTS)
Stressful events (PTS) - Question identifier:PTS_R05
Throughout life, sometimes things happen to people that are unusually or especially frightening, stressful or traumatic. Examples include experiencing sudden loss of someone close, witnessing or experiencing actual or threatened serious injury or illness, a serious accident or fire, exposure to violence, etc.
The following questions may be sensitive to some people, but we have to ask the same questions of everyone.
Stressful events (PTS) - Question identifier:PTS_Q05
Have you ever experienced any of the following highly stressful or traumatic events during your life?
- 01: Natural disaster (e.g., flood, hurricane, tornado, earthquake)
- 02: Fire or explosion
- 03: Transportation accident (e.g., car accident, boat accident, train wreck, plane crash)
- 04: Serious accident at work, home, or during recreational activity
- 05: Exposure to toxic substance (e.g., dangerous chemicals, radiation)
- 06: Physical assault (e.g., being attacked, hit, slapped, kicked, beaten up)
- 07: Assault with a weapon (e.g., being shot, stabbed, threatened with a knife, gun, bomb)
- 08: Sexual assault (e.g., rape, attempted rape, made to perform any type of sexual act through force or threat of harm)
- 09: Other unwanted or uncomfortable sexual experience
- 10: Combat or exposure to a war-zone (in the military or as a civilian)
- 11: Captivity (e.g., being kidnapped, abducted, held hostage, prisoner of war)
- 12: Life-threatening illness or injury
- 13: Severe human suffering
- 14: Sudden violent death (e.g., homicide, suicide)
- 15: Sudden accidental death
- 16: Serious injury, harm, or death you caused to someone else
- 17: Any other very stressful event or experience
- 18: None of the above
Stressful events (PTS) - Question identifier:PTS_R10
For the following questions, the event that caused you the most reactions will be referred as your worst event.
Stressful events (PTS) - Question identifier:PTS_Q10
What was the worst event that you experienced?
- 01: Natural disaster
- 02: Fire or explosion
- 03: Transportation accident
- 04: Serious accident at work, home, or during recreational activity
- 05: Exposure to toxic substance
- 06: Physical assault
- 07: Assault with a weapon
- 08: Sexual assault
- 09: Other unwanted or uncomfortable sexual experience
- 10: Combat or exposure to a war-zone (in the military or as a civilian)
- 11: Captivity
- 12: Life-threatening illness or injury
- 13: Severe human suffering
- 14: Sudden violent death
- 15: Sudden accidental death
- 16: Serious injury, harm, or death you caused to someone else
- 17: Any other very stressful event or experience
Stressful events (PTS) - Question identifier:PTS_Q15
How did you experience this event?
- 1: It happened to me directly
- 2: I witnessed it
- 3: I learned about it happening to a close family member or a close friend
- 4: I was repeatedly exposed to details about it as part of my job (e.g., paramedic, police, military, or other first responder)
Stressful events (PTS) - Question identifier:PTS_Q20
How old were you when the worst event happened, or first happened?
Age in years
Min = 0; Max = 121
Stressful events (PTS) - Question identifier:PTS_Q25A
Was your worst event related to something that happened while you were at work?
- 1: Yes, related to current occupation
- 2: Yes, related to past occupation
- 3: No
Stressful events (PTS) - Question identifier:PTS_Q25B
What kind of work were you doing?
Specify the kind of work you were doing
Long Answer Length = 80
Stressful events (PTS) - Question identifier:PTS_Q25C
What were your most important activities or duties?
Specify your most important activities or duties
Long Answer Length = 80
Stressful events (PTS) - Question identifier:PTS_Q30
Was the worst event that you have ever experienced related to the COVID-19 pandemic?
- 1: Yes
- 2: No
Stressful events (PTS) - Question identifier:PTS_Q35A
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Repeated, disturbing, and unwanted memories of the stressful experience
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35B
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Repeated, disturbing dreams of the stressful experience
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35C
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Suddenly feeling or acting as if the stressful experience were actually happening again, as if you were actually back there reliving it
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35D
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Feeling very upset when something reminded you of the stressful experience
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35E
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Having strong physical reactions when something reminded you of the stressful experience
e.g., heart pounding, trouble breathing, sweating
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35F
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Avoiding memories, thoughts, or feelings related to the stressful experience
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35G
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Avoiding external reminders of the stressful experience
e.g., people, places, conversations, activities, objects, or situations.
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35H
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Trouble remembering important parts of the stressful experience
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35I
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Having strong negative beliefs about yourself, other people, or the world
e.g., having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35J
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Blaming yourself or someone else for the stressful experience or what happened after it
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35K
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Having strong negative feelings such as fear, horror, anger, guilt, or shame
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35L
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Loss of interest in activities that you used to enjoy
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35M
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Feeling distant or cut off from other people
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35N
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Trouble experiencing positive feelings
e.g., being unable to feel happiness or have loving feelings for people close to you
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35O
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Irritable behavior, angry outbursts, or acting aggressively
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35P
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Taking too many risks or doing things that could cause you harm
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35Q
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Being "superalert" or watchful or on guard
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35R
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Feeling jumpy or easily startled
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35S
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Having difficulty concentrating
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Stressful events (PTS) - Question identifier:PTS_Q35T
Keeping your worst event in mind, over the past month, how much have you been bothered by the following problems?
Trouble falling or staying asleep
- 1: Not at all
- 2: A little bit
- 3: Moderately
- 4: Quite a bit
- 5: Extremely
Mental health (SUI)
Mental health (SUI) - Question identifier:SUI_R001
The following questions may be sensitive to some people, but we have to ask the same questions of everyone.
Mental health (SUI) - Question identifier:SUI_Q005
Have you ever seriously contemplated suicide?
- 1: Yes
- 2: No
Mental health (SUI) - Question identifier:SUI_Q010
Have you ever seriously contemplated suicide as a result of the worst event that you have ever experienced?
- 1: Yes
- 2: No
Social impacts of stressful events (SIP)
Social impacts of stressful events (SIP) - Question identifier:SIP_Q05
In the past 12 months, have problems related to your worst event affected any of the following aspects of your life?
- 1: Your home responsibilities, like cleaning, shopping and taking care of the house or apartment
- 2: Your ability to attend school
- 3: Your ability to work at a job
- 4: Your family life (e.g., relationship with spouse or dependents)
- 5: Your ability to form or maintain close relationships with other people
- 6: Your social life
- 7: None of the above
Mental health services - contact with health professionals (SR1)
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q05A_01
During the past 12 months, have you talked to any of the following people about problems related to your worst event?
- 1: Psychiatrist
- 2: Family doctor or general practitioner
- 3: Psychologist
- 4: Nurse
- 5: Social worker, counsellor, or psychotherapist
- 6: Another health professional
- 7: None of the above
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q05A
How many times did you talk to a psychiatrist about problems related to your worst event?
Number of consultations
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20
- 21: 21
- 22: 22
- 23: 23
- 24: 24
- 25: 25 or more
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q05B
How many times did you talk to a family doctor or general practitioner about problems related to your worst event?
Number of consultations
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20
- 21: 21
- 22: 22
- 23: 23
- 24: 24
- 25: 25 or more
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q05C
How many times did you talk to a psychologist about problems related to your worst event?
Number of consultations
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20
- 21: 21
- 22: 22
- 23: 23
- 24: 24
- 25: 25 or more
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q05D
How many times did you talk to a nurse about problems related to your worst event?
Number of consultations
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20
- 21: 21
- 22: 22
- 23: 23
- 24: 24
- 25: 25 or more
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q05E
How many times did you talk to a social worker, counsellor, or psychotherapist about problems related to your worst event?
Number of consultations
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20
- 21: 21
- 22: 22
- 23: 23
- 24: 24
- 25: 25 or more
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q05F
How many times did you talk to another health professional about problems related to your worst event?
Number of consultations
- 01: 1
- 02: 2
- 03: 3
- 04: 4
- 05: 5
- 06: 6
- 07: 7
- 08: 8
- 09: 9
- 10: 10
- 11: 11
- 12: 12
- 13: 13
- 14: 14
- 15: 15
- 16: 16
- 17: 17
- 18: 18
- 19: 19
- 20: 20
- 21: 21
- 22: 22
- 23: 23
- 24: 24
- 25: 25 or more
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q10A
Did you experience any of the following problems with the scheduling of your appointments?
- 1: One or more of your appointments was cancelled, rescheduled or delayed due to the COVID-19 pandemic
- 2: One or more of your appointments was cancelled, rescheduled or delayed due to other reasons (Exclude any reason related to the COVID-19 pandemic.)
- 3: One or more of your appointments has not been scheduled yet
- 4: Did not experience any problems with the scheduling of your appointments
Mental health services - contact with health professionals (SR1) - Question identifier:SR1_Q15A
Did you experience any other difficulties getting the health care service you needed?
- 01: Difficulty getting a referral
- 02: Waited too long between booking appointment and visit
- 03: Service not available in your area
- 04: Transportation (e.g., travel restrictions, lack of public transportation)
- 05: Cost
- 06: Quarantine rules or office closures
- 07: Service not available in the official language of your choice
- 08: Lack of availability of culturally appropriate health services
- 09: Lack of First Nations, Métis or Inuit traditional medicines, healing or wellness practices
- 10: Other
- 11: None of the above
Alcohol (ALC)
Alcohol (ALC) - Question identifier:ALC_R05
The following questions are about your alcohol consumption.
Alcohol (ALC) - Question identifier:ALC_Q05
During the past 30 days, did you have a drink of beer, wine, liquor or any other alcoholic beverage?
- 1: Yes
- 2: No
Alcohol (ALC) - Question identifier:ALC_Q10
During the past 30 days, on those days when you drank alcoholic beverages, how many drinks did you usually have?
Number of drinks
Min = 0; Max = 99
Alcohol (ALC) - Question identifier:ALC_Q15
During the past 30 days, how often have you had [5/4] or more drinks on one occasion?
- 1: Daily or almost daily
- 2: 2 to 5 times a week
- 3: Once a week
- 4: 2 to 3 times in the past 30 days
- 5: Once in the past 30 days
- 6: Not in the past 30 days
Cannabis (CAN)
Cannabis (CAN) - Question identifier:CAN_R05
The following questions are about your cannabis consumption.
Cannabis (CAN) - Question identifier:CAN_Q05
In the past 30 days, how often did you use cannabis?
- 01: Never used cannabis
- 02: Used previously but not in the past 30 days
- 03: 1 day in the past 30 days
- 04: 2 or 3 days in the past 30 days
- 05: 1 or 2 days per week
- 06: 3 or 4 days per week
- 07: 5 or 6 days per week
- 08: Daily
Cannabis (CAN) - Question identifier:CAN_Q10
What is the main reason you use cannabis?
- 1: Medical use with a medical document
- 2: Medical use without a medical document
- 3: Non-medical use
- 4: Both medical use and non-medical use
Social provisions (SPS)
Social provisions (SPS) - Question identifier:SPS_R05
The following questions are about your current relationships with friends, family members, co-workers, community members, and so on.
Social provisions (SPS) - Question identifier:SPS_Q05A
Please indicate to what extent each statement describes your current relationships with other people.
There are people I can depend on to help me if I really need it
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05B
Please indicate to what extent each statement describes your current relationships with other people.
There are people who enjoy the same social activities I do
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05C
Please indicate to what extent each statement describes your current relationships with other people.
I have close relationships that provide me with a sense of emotional security and well-being
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05D
Please indicate to what extent each statement describes your current relationships with other people.
There is someone I could talk to about important decisions in my life
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05E
Please indicate to what extent each statement describes your current relationships with other people.
I have relationships where my competence and skill are recognized
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05F
Please indicate to what extent each statement describes your current relationships with other people.
There is a trustworthy person I could turn to for advice if I were having problems
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05G
Please indicate to what extent each statement describes your current relationships with other people.
I feel part of a group of people who share my attitudes and beliefs
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05H
Please indicate to what extent each statement describes your current relationships with other people.
I feel a strong emotional bond with at least one other person
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05I
Please indicate to what extent each statement describes your current relationships with other people.
There are people who admire my talents and abilities
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Social provisions (SPS) - Question identifier:SPS_Q05J
Please indicate to what extent each statement describes your current relationships with other people.
There are people I can count on in an emergency
- 1: Strongly agree
- 2: Agree
- 3: Disagree
- 4: Strongly disagree
Indigenous identity (IS)
Indigenous identity (IS) - Question identifier:IS_Q01
Are you First Nations, Métis or Inuk (Inuit)?
- 1: No
- 2: Yes, First Nations
- 3: Yes, Métis
- 4: Yes, Inuk (Inuit)
Sociodemographic characteristics (PG)
Sociodemographic characteristics (PG) - Question identifier:PG_Q05
The following question collects information in accordance with the Employment Equity Act and its Regulations and Guidelines to support programs that promote equal opportunity for everyone to share in the social, cultural, and economic life of Canada.
- 01: White
- 02: South Asian (e.g., East Indian, Pakistani, Sri Lankan)
- 03: Chinese
- 04: Black
- 05: Filipino
- 06: Arab
- 07: Latin American
- 08: Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai)
- 09: West Asian (e.g., Iranian, Afghan)
- 10: Korean
- 11: Japanese
- 12: Other
Place of birth, immigration and citizenship (DEM1)
Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30A
Where were you born?
- 1: Born in Canada
- 2: Born outside Canada
Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30B
Are you a Canadian citizen?
- 1: Yes, a Canadian citizen by birth
- 2: Yes, a Canadian citizen by naturalization (Canadian citizen by naturalization refers to an immigrant who was granted Citizenship of Canada under the Citizenship Act.)
- 3: No, not a Canadian citizen
Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q30C
Are you a landed immigrant or permanent resident?
- 1: No
- 2: Yes
Place of birth, immigration and citizenship (DEM1) - Question identifier:DEM1_Q35
In what year did you first become a landed immigrant or a permanent resident?
Min = 1900; Max = 2021
Marital status (MS)
Marital status (MS) - Question identifier:MS_Q01
What is your marital status?
- 1: Married (For Quebec residents only, select the "Married" category if your marital status is "civil union".)
- 2: Living common law (Two people who live together as a couple but who are not legally married to each other.)
- 3: Never married (not living common law)
- 4: Separated (not living common law)
- 5: Divorced (not living common law)
- 6: Widowed (not living common law)
Education (ED)
Education (ED) - Question identifier:ED_Q05
What is the highest certificate, diploma or degree that you have completed?
- 1: Less than high school diploma or its equivalent
- 2: High school diploma or a high school equivalency certificate
- 3: Trade certificate or diploma
- 4: College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
- 5: University certificate or diploma below the bachelor's level
- 6: Bachelor's degree (e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B)
- 7: University certificate, diploma or degree above the bachelor's level
Total household income (THI)
Total household income (THI) - Question identifier:THI_R01
Now a question about total household income.
Total household income (THI) - Question identifier:THI_Q01
What is your best estimate of your total household income received by all household members, from all sources, before taxes and deductions, during the year ending December 31, 2020?
Rounded to the nearest CAN$
Min = -99999999; Max = 99999999
Would you like to sign-up for future surveys? (UCE)
Would you like to sign-up for future surveys? (UCE) - Question identifier:UCE_R01
Statistics Canada is planning future surveys on mental health, including a potential follow-up to this survey.
Would you like to sign-up for future surveys? (UCE) - Question identifier:UCE_Q01
Would you like to sign-up for future surveys or future mental health surveys?
- 1: Yes
- 2: No
Would you like to sign-up for future surveys? (UCE) - Question identifier:UCE_Q05B
Please provide the following information so we can email you to participate in a follow-up survey or future mental health surveys.
Email address
Long Answer Length = 80
Data sharing agreements (DSA)
Data sharing agreements (DSA) - Question identifier:DSA_R01
To avoid duplication of surveys, Statistics Canada may enter into agreements to share the data from this survey, including postal code, with provincial and territorial ministries of health, [the Institut de la statistique du Québec,/BLANK] Health Canada and the Public Health Agency of Canada. [The Institut de la statistique du Québec and provincial ministries/Provincial ministries] of health may make the data available to local health authorities. Only organizations that have agreed to keep your information confidential and use it only for statistical purposes will receive the data.
Data sharing agreements (DSA) - Question identifier:DSA_Q01
Do you agree to share your information with provincial and territorial ministries of health, [the Institut de la statistique du Québec,/BLANK] Health Canada and the Public Health Agency of Canada?
- 1: Yes
- 2: No
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